Objective? To investigate the pathogenesis, diagnosis, and treatment of unilateral gluteal muscle contracture. Methods Between January 1990 and September 2009, 41 patients with unilateral gluteal muscle contracture were treated and the cl inical data were retrospectively analysed. Among them, 24 were male and 17 were female with an age range from 6 to 29 years (mean, 12 years). Thirty-nine patients had a definite history of repeat intragluteal injection. The locations were the left side in 9 cases and the right side in 32 cases. The main cl inical manifestations included lameness and abnormal gait. The medical examination showed pelvic obl ique and relative inequal ity of lower l imbs with a mean difference of 2.1 cm (range, 1.2-3.8 cm) in the distance form navel to malleolus medials. The X-ray films of pelvis showed outpouching trochanter of femur and pelvic obl ique. The CT scans showed no abnormal finding except pelvic obl ique and gluteal muscle contracture. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, followed by the skin traction of both legs and rehabil itation exercise. Results All incisions healed by first intention. Forty-one patients were followed up 1-20 years (mean, 5 years), and the signs of gluteal muscle contracture disappeared. After 1 year of operation, 34 patients had equal leg length, 5 patients had mild pelvic obl ique, and 2 patients had obvious pelvic obl ique. According to LIU Guohui et al. evaluation standard, the results were excellent in 33 cases, good in 6 cases, and poor in 2 cases with an excellent and good rate of 95.12% at 1 year after operation. Conclusion Unilateral gluteal muscle contracture leads to pelvic obl ique and inequal ity of lower l imbs, and it can be cured with the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and rehabil itation exercises.
Objective To discuss the surgical procedures and curative effect of stiff 2-5 metacarpophalangeal (MP) joints after crash injury in hand. Methods Between January 2006 and June 2009, 7 cases of stiff 2-5 MP joints were treated by releasing the stiff MP joints and reconstructing the function of lumbrical muscle in one stage. There were 6 males and 1 female with an average age of 32 years (range, 18-56 years). All injuries were caused by crash. Six cases suffered from multiple metacarpal fracture or complex dislocation of MP joint and 1 case suffered from complete amputation at level of middle palm of hand. The interval from initial wound heal ing to hospital ization was 3 to 15 months. Before operation, the X-ray films showed fracture healed and the results of nipping paper test were positive. All hands were treated with physical therapy for 1 month. After the plaster external fixation for 6 weeks, the physical therapy and function training were given. Results All wounds healed by first intention. The patients had no joint instabil ity and extensor tendon side-sl ipping with normal finger function. Six patients were followed up from 6 months to 3 years. The extension and flexion of MP joint were 0° and 67-90°, respectively. The average grip strength of injured dominant hand reached 86.70% of normal side and non-dominant hand reached 66.70% of normal side. The average injured dominant tip pinch strength reached 83.52% of normal side and non-dominant tip pinch strength reached 61.30% of normal side. Based on total active motion (TAM) system of Chinese Medical Association for Hand Surgery, the results were excellent in 4 cases, good in 1 case, and fair in 1 case; the excellent and good rate was 83.33%. Conclusion In patients with stiff MP joint and lumbrical muscle defect, releasing stiff MP joint and reconstructing lumbrical function in one stage can recover the function of MP joint and achieve good outcome. Physical therapy plays an important role before operation.
Objective To study in vitro sustained release behaviour of the recombinant human bone morphogenetic protein 2(rhBMP-2) from the sample which porous calcium phosphate cement (PCPC) was combined with rhBMP-2, and to evaluate the effect of PCPC/rhBMP-2 composite on repairing bone defect in the animalstudy.Methods rhBMP-2 was absorbed into PCPC by vacuum-adsorption and freeze-dried at -40℃, the PCPC/rhBMP-2 enwrapped with chitosan as the experimental group, the pure PCPC/rhBMP-2 as the control group, then the sustained release ofrhBMP-2 from PCPC was determined in simulated body fluid (SBF) by UV-VIS spectrophotometer. At same time, the PCPC/rhBMP-2 composites with chitosan were implanted into the (4.2 mm×5.0 mm femora defects of rabbits, which were considered as the experimental group, whereas in the control group only PCPC was implanted. The effect of repairingbone defect was evaluated in the 4th and 8th week postoperatively by radiograph and histomorphology.Results The PCPC have a high absorption efficiency to rhBMP-2, and the release of rhBMP-2 was sustained release system. The release of rhBMP-2 from PCPC in the experimental group (99% after 350 hours) was slowerthan that in the control group (100% after 150 hours). In the experimental group, the radiological and histomorphological evaluations showed that theinterfaces between the materials and host bones became blurred both at 4th and 8th week. The implanted materials were partially absorbed, and the implanted areas exhibited the formation of new bone. In the control group, a little amount of new bones was observed. Conclusion The PCPC shows great clinical potential as a carrier for rhBMP-2. The PCPC/rhBMP-2 composite possesses much potentialities of osteoinductivity and the ability of repairing bone defect, so it can be used as a novel bone substitute clinically.
Objective To compare the in vitro release and transdermal capability between Erhuang gel paste and its ointment. Methods Strat-M membrane and advanced Franz diffusion cell were used to conduct the in vitro release and transdermal experiment. The content of osthole, the effective component of the key herb radix angelicae tuhuo in the preparations was quantitatively determined by high performance liquid chromatography (HPLC) method to determine the in vitro release rate, transdermal quantity and transdermal rate. Results The transdermal penetration formula of Erhuang gel paste was Ln=0.443 6t+1.350 9, r=0.964 4. The cumulative in vitro release rate, transdermal quantity and transdermal rate were respectively 62.90%, 0.067 2 mg/g and 20.82%. The transdermal penetration formula of Erhuang ointment was Ln=0.205 1t-0.244 7, r=0.995 6. The cumulative in vitro release rate, transdermal quantity and transdermal rate were respectively 77.64%, 0.013 1mg/g and 9.36%. Conclusion The transdermal capability of Erhuang gel paste is obviously better than its ointment, and the gel paste is more convenient to use and is unlikely to cause allergic reactions.